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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1465986



Case Details

VAERS ID: 1465986 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: COVID19 Moderna Vaccine given to 12yrs old patient. No adverse reaction/symtoms noted after vaccine given.


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